9 Causes of Hematemesis

Throwing up drops of blood or blood clots is a medical emergency

Medically reviewed by Jay N. Yepuri, MD, MS

"Hematemesis" is the medical term used to describe vomiting blood. The blood can be bright red, dark red, black, or dark brown, or resemble coffee grounds. It is caused by internal gastrointestinal (GI) bleeding and is considered a serious condition that requires medical attention.

This article discusses the causes, appearance, and treatment options for those with hematemesis.

What Causes Hematemesis?

Several health disorders affect the health of the GI tract and can lead to vomiting blood. Causes include:

Gastritis

Gastritis is inflammation of the stomach lining. It can develop for several reasons, including:

• Infections such as Helicobacter pylori (H. pylori)

• Taking nonsteroidal anti-inflammatory drugs (NSAIDs) too often

• Smoking

• Long-term stress

• Eating fatty, sugary, or spicy foods

• Excessive alcohol intake

• Bile reflux, which is a condition that develops when bile flows into the stomach from the small intestine, causing damage

If you vomit blood, you should head to your nearest emergency room (ER). While not all cases are life-threatening, they all indicate some internal bleeding and require medical attention.

Learn More:How Chronic Gastritis Is Treated

Stomach Ulcers

A stomach ulcer, also called a peptic ulcer, is an open sore that develops in the stomach lining. Typically, ulcers are caused by an H. pylori infection or overusing NSAIDs.

Learn More:Identifying and Treating Different Types of Ulcers

Gastroesophageal Reflux Disease (GERD)

GERD is a form of reflux disease that develops because of compromised acid flow. The stomach contains acids to help break down food, but when that acid flows backward into the esophagus (the food tube that connects the mouth and stomach), it can irritate the esophagus lining, leading to symptoms.

The condition is often associated with reduced pressure in the esophageal sphincter, which is the area at the bottom of the esophagus designed to open and close as necessary while eating or drinking. Other conditions that are associated with GERD include:

• Hiatal hernias (part of the stomach protrudes into the chest through the diaphragm)

• Impaired esophageal clearance (abnormal emptying of the esophagus)

• Delayed gastric (stomach) emptying

Some possible risk factors associated with the development of GERD include:

• Having obesity

• Older age

• Smoking cigarettes

• Mood disorders such as anxiety or depression

• A lack of physical activity

• Eating high-acid foods

• Eating late in the day

Severe GERD is more likely to present with bleeding because of damage to the gastrointestinal tract.

Learn More:GERD Facts and Statistics: What You Need to Know

Alcohol-Related Liver Disease

Excessive alcohol consumption can lead to liver damage and disease over time. The liver is meant to help filter out and process alcohol. However, if the amount of alcohol in a person’s system is too much for the liver to handle, the organ becomes damaged. The most severe case of alcohol-related liver disease, cirrhosis of the liver, is associated with vomiting blood.

Damage to the Trachea, Stomach, and Esophagus

When a person is ill and coughing a lot, the force can cause damage to the windpipe (trachea), stomach, and esophagus. There are two possible reasons why coughing a lot while sick can lead to enough damage to cause vomiting blood.

The first is gastropathy. The condition is characterized as bleeding from the stomach lining because of dilated blood vessels. The second is called Mallory-Weiss tears, which are tears in the lower esophagus that can lead to bleeding. Gastropathy and Mallory-Weiss tears can both develop because of respiratory illness.

Esophageal Cancer

Esophageal cancer is cancer of the esophagus. During the early stages of this cancer, people don’t often experience any symptoms at all. As the disease progresses, a person may experience other symptoms that include vomiting blood because of bleeding in the GI tract.

Learn More:Coping With Esophageal Cancer

Stomach Cancer

Like esophageal cancer, stomach cancer may not present with symptoms right away. However, as it spreads and worsens over time, people can develop many symptoms, including bloody vomit.

Learn More:Signs and Symptoms of Stomach Cancer

Blood-Clotting Conditions

Some conditions, such as hemophilia, lead to issues with blood-clotting in the body. If the blood cannot clot as it should, it can lead to internal bleeding. This internal bleeding can happen within the gastrointestinal tract and cause the into vomiting of blood.

Bleeding in the GI tract is not common in people with blood disorders such as hemophilia. When it does happen, it is considered a medical emergency and should be examined by a healthcare provider.

Learn More:What Are Coagulopathy Disorders?

Medications

When taken in excess or not as directed, several medications can lead to GI bleeding that can cause you to vomit blood. Some possible medications with this side effect include:

• NSAIDs such as Advil or Motrin (ibuprofen) and Aleve (naproxen)

• Platelet inhibitors such as acetylsalicylic acid, Plavix (clopidogrel), and Effient (prasugrel)

• Anticoagulant medications such as vitamin K antagonists, heparin, or direct oral anticoagulants (DOAKs)

The likelihood of experiencing drug-induced GI bleeding isn’t high, but when it happens, it is serious.

Throwing Up Blood: What Does It Look Like?

Vomiting blood can take on many appearances. There can be blood mixed in with food or blood on its own, and the amount of blood can also differ depending on the person and the type of bleed.

Blood in the vomit can appear:

• Bright red

• Dark red

• Dark Brown

• Black

• Be the appearance of coffee grounds

All types of blood, from bright red to resembling coffee grounds, should be considered severe and investigated by a healthcare provider.

Should You Worry About a Little Blood in Vomit?

Any blood in your vomit is a sign that something isn’t right within your body. Because of that, you should always get it checked by a healthcare provider. While it may not always be life-threatening, any internal bleeding detected in vomit should be taken seriously.

A healthcare provider should investigate all bloody vomit. That said, if you experience any of the following symptoms alongside bloody vomiting, call 911 or head to your nearest emergency department immediately. Signs include:

• Weakness

• Feeling faint

• Dizziness

• Rapid or shallow breathing

• Cold, pale, and clammy skin

• Pain in the stomach

• Black stools

Hematemesis Treatment

Treatment for hematemesis depends on how severe the bleeding is. However, there are some standard therapies used to help treat the condition, including:

• Blood transfusions to combat loss of blood

• Proton pump inhibitors to reduce stomach acid

• Medications designed to stop bleeding, such as somatostatin and octreotide

• Tranexamic acid, which is a medication that inhibits the breakdown of blood, to slow and prevent further bleeding

• Endoscopic interventions to stop bleeding

The proper treatment will be chosen based on personal circumstances.

Summary

"Hematemesis" is the medical term for vomiting blood. All instances of bloody vomit should be considered severe medical conditions and investigated by a healthcare provider or seen by an emergency physician.

There are many underlying causes associated with vomiting blood, all of which come with other signs and symptoms. However, as vomiting blood can be severe, finding the cause and beginning treatment promptly is vital.